Application of a dental adhesive using the self-etch and etch-and-rinse approaches: an 18-month clinical evaluation

Laboratory investigations have demonstrated that the application of multiple adhesive coats can increase adhesive infiltration, thereby increasing bond strength values. The authors conducted an 18-month, randomized, controlled prospective study to evaluate the clinical performance of a self-etch and an etch-and-rinse adhesive in noncarious cervical lesions.

Twenty-nine patients with at least two pairs of similarly sized lesions participated in this study. The authors placed 116 restorations in one of four groups: OS2 (phosphoric acid and dental adhesive [One-Step Plus, Bisco, Schaumburg, Ill.], following the manufacturer's recommendation [two coats]); OS4 (phosphoric acid and One-Step Plus, with four coats); TY2 (Tyrian SPE [Bisco] and One-Step Plus, following the manufacturer's recommendation [two coats]); and TY4 (Tyrian SPE and One-Step Plus, with four coats). The authors evaluated the restorations at baseline and at six, 12 and 18 months, according to modified U.S. Public Health Service criteria. (Eight of the 116 restorations were unavailable for follow-up.)

The retention rate for the TY2 group (55.5 percent) was statistically lower than that for the TY4 (77.8 percent) and OS4 (88.9 percent) groups. Only teeth in OS4 exhibited a retention rate at 18 months that was similar to that observed at baseline. Marginal discoloration occurred in all groups, and it was statistically significantly worse in TY2.

Multiple adhesive coats significantly improved retention rates.

Applying multiple coats of adhesive with the etch-and-rinse or self-etch approach can improve retention rates of Class V resin-based composite restorations, although not to the level of the American Dental Association's guidelines for dentin and adhesive materials.